AccountId: 011433970860
ContactId: ea185731-528c-4dfb-adc8-4aaa26fe08f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227619 ms
Total Talk Time (AGENT): 100383 ms
Total Talk Time (CUSTOMER): 90143 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/ea185731-528c-4dfb-adc8-4aaa26fe08f3_20250106T17:01_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from William Baus Hospital. Um, I'm not sure if I have the right, uh, number or not, but I was calling to follow up on a claim. It says it's an APL claim.
[AGENT][NEUTRAL] OK, well, I can help you with the claim status. Um, [PII], may I have a good contact number in case we're disconnected and then the um the member's policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure, um, my phone number it's [PII] and it's direct and the ID number I have is 0175.
[CUSTOMER][NEUTRAL] 856-3.
[AGENT][NEUTRAL] OK, thank you. 856-3.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], and it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Sure, it's for [PII].
[AGENT][NEUTRAL] And the total bill?
[CUSTOMER][NEUTRAL] Uh, $5,689.93.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so I'm sure I received the claim on [PII].
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And the um claim number is 353.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9504.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was also, well, it's denied, but
[AGENT][NEUTRAL] Uh, additional information. So it's denied because our records indicate that the premium for the data service was not received, therefore benefits are not payable.
[CUSTOMER][NEUTRAL] Hm, OK.
[CUSTOMER][NEUTRAL] All right, so she is it so is it still showing active with you guys or?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] On the.
[CUSTOMER][NEUTRAL] Premium is paid.
[AGENT][NEUTRAL] 563. So actually, whoa, actually, this policy hasn't been active since [PII].
[CUSTOMER][POSITIVE] Oh, alrighty.
[AGENT][NEUTRAL] And I'm looking to see that, yeah, that was the last medical, that was the last of any policy that they had with us. So it wasn't even active on the data service.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh all right then, let me, uh, update that. Do you when was her effective date?
[AGENT][NEUTRAL] So this is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me update that.
[CUSTOMER][POSITIVE] All right, well let me, let me get in touch with her then I'm not sure what she has currently but um I appreciate your help.
[AGENT][POSITIVE] Well, you're very welcome. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, oh, is there a call reference number for today?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. So that's [PII] and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, all right, [PII], thank you so much for your help.
[AGENT][POSITIVE] You're very welcome, [PII]. Thanks for calling APL. I hope you have a great week.
[CUSTOMER][POSITIVE] You too, thank you. Bye bye.
[AGENT][POSITIVE] Thank you, you're welcome. Bye bye.